If you’re like most Americans, chances are you will suffer from lower back pain at some point in your lifetime. Back pain can happen suddenly - after lifting one too many heavy boxes - or can develop gradually over time as we age. In fact, back pain has become so common in the United States that it is now the #2 reason people go to their doctor’s office.
Typically, the lower back (the five vertebrae of the lumbar spine) is where most back pain happens. As we become older, changes occur in our lumbar spines that can cause pain. In most cases, these changes are simply degenerative arthritis, which is the wearing out of cartilage over time.
Fortunately, in most cases, back pain goes away in a few days or weeks. Statistics say that roughly 90% of patients with low back pain will see improvement in their symptoms regardless of treatment within six weeks or less.
During the time of the initial onset of your lower back pain, your doctor may recommend these standard first-line treatment options:
- physical therapy
- injections in the spine
Non-surgical treatmentslike these are usually very effective in resolving most cases of back pain within a very short timeframe.
Surgical options (for severe cases)
For a small number of people, however, lower back pain does not go away with standard treatment. For a minority of patients, the pain persists month after month, often growing worse over time.
For these patients, surgery may be the best treatment option.
At El Camino Hospital, our expert neurosurgeons and orthopedic spine surgeons have many different surgical options available, which are customized for each patient based on the specific cause of the back pain.
One of the more complex operations, discussed in detail below, is lumbar spinal fusion surgery.
Lumbar spinal fusion surgery
For those who suffer from certain back conditions, spinal fusion surgery may be recommended. Approximately 400,000 Americans have spinal fusion surgery each year, making it one of the most common types of back surgery available today.
Lumbar spinal fusion is an operation that causes the bones of the spine in the lower back to grow together, or fuse.
Fusing two bones, or vertebrae, eliminates all motion between them - motion that was once painful. Moreover, removing the disc between the two vertebrae and removing any associated bone spurs also reduces pressure on the nerves of the spine, alleviating pain as well.
In short, spinal fusion can help to eliminate what’s causing you to feel pain in your back, allowing you to return to your normal activities of daily living. At El Camino Hospital, our patients have reported good-to-excellent results in 85 to 90 percent of the cases.
Types of lumbar spinal fusion surgery
There are many different surgical approaches to spinal fusion. These include:
- Surgery through an incision in the back
- Surgery through an incision in the abdomen
- Surgery through incisions in both the back and abdomen
In many cases, metal screws and rods are placed into the bones to hold them steady while the fusion occurs. During an interbody fusion, the surgeon first removes the damaged disc between the bones and places a piece of new material (bone, metal or plastic) in its place.
The decision on what type of fusion is best for you will be based on your specific complaints and the cause of your symptoms.
In the right patient, spinal fusion can be very effective.
Minimally-invasive lumbar spinal fusion
Surgeons at El Camino Hospital are now using a less invasive approach to spinal fusion, which can result in a quicker recovery for the patient.
Minimally-invasive lumbar spinal fusion is similar to traditional lumbar spinal fusion, but uses smaller incisions and causes less damage to the surrounding tissues during surgery. In the minimally-invasive approach, a tiny viewing camera is used inside the body while the surgeon operates with special instruments, similar to other minimally-invasive procedures (such as laparoscopic gallbladder or appendix removal).
There are many techniques available to fuse the vertebrae together using a minimally-invasive approach. Typically, the procedure includes four basic steps:
- A very small incision is made in the skin
- The damaged disc is removed along with any parts of the bone that are pinching nerves
- A spacer/bone graft takes the place of the removed disc (bone can be taken from your own bone, a bone bank and/or synthetic bone)
- Screws then secure the vertebrae until the bone graft fuses (the graft takes approximately 12 weeks to “set”)
Advantages of minimally-invasive lumbar spinal fusion
At El Camino Hospital, our neurosurgeons and orthopedic spine surgeons have had excellent outcomes to date with minimally-invasive spinal fusion surgery.
Advantages to this approach include:
- smaller incisions
- less damage to the surrounding tissues, because your surgeon won’t need to cut through muscles in order to reach the spine
- less pain following surgery
- less blood loss/reduced need for blood transfusions
- less need for narcotic pain medications after surgery
- fewer complications
- shorter hospital stay
- shorter recovery time
Conditions treated through lumbar spinal fusion
Lumbar spinal fusion is often recommended for persistent lower back pain that does not get better with other treatments. Once your surgeon has performed a full diagnostic evaluation of your particular case, surgical options will be discussed with you.
- Spinal fusion is typically done in these situations:
- As part of an operation for spinal stenosis (when bone spurs grow into the spinal canal and pinch the spinal cord/nerve roots)
- After removal of a damaged disc in the spine, often due to degenerative disc disease
- After an injury or fracture to the bones (vertebrae) in the spine
- To strengthen a weak or unstable spine caused by infection or tumors
- For spondylolisthesis, a condition in which one vertebrae slips forward on top of another
- For abnormal curvatures of the spine, such as those from scoliosis or kyphosis
Learning more about lumbar spinal fusion
It’s important to realize that not every patient with back pain is a candidate for lumbar spinal fusion. Because the majority of patients with lower back pain recover within six weeks regardless of treatment, surgery is only recommended in a very small number of cases.
To determine whether surgery is a possibility for you, first talk to your regular physician. If you are a potential candidate for surgery, you will be referred to either a neurosurgeon or an orthopedic spine surgeon for further evaluation. At that point, you still may want to get a second opinion, as back surgery is a serious procedure and requires careful consideration.